Harrison Ruess: Our fixation on the U.S. is a barrier to Canadian progress
Harrison Ruess: Our fixation on the U.S. is a barrier to Canadian progress
There is nobody, anywhere, seriously suggesting that Canada should import American-style health care to our country.
By: Harrison Ruess
Let’s start with a couple positives today. (Sorry, Jen.)
A health-care debate is genuinely getting underway. This is certainly true in Ontario, as this province contemplates some tweaks to health-care delivery. But it is spilling out into other regions as well — partly because of the Toronto-centric nature of media coverage in our country, but also because there are genuine debates happing elsewhere too. It’s even popping up on the federal scene.
There’s also, dare I say it aloud without jinxing anything, an actual possibility of health-care change and improvement in the air.
These are both good things. Overdue yes. But still very, very good.
The flipside of the debate that’s getting underway is that it’s featuring an age-old tactic that shouldn’t work nearly as well as it does in a country that claims to be globally aware: the only country we’re comparing ourselves to is the United States.
This sole-sourced comparison is nuts. It is only done to stop Canada from progressing.
About a year ago I wrote here that Canada needs an HBO moment, akin to the opening scene from that network’s show The Newsroom. I won’t repeat the points of that essay, but as our “HBO moment,” gets underway, allow me to build on three key themes.
First, to be emphatic on this point, we need to be realistic about where our system ranks globally.
It is truly bewildering to me the lengths that otherwise smart and empathetic Canadians will go to to defend the status-quo approach to health care in Canada. The results we get, versus the money we spend, is simply not brag-worthy. The argument that our system works great, if only we threw more money at it, doesn’t stand up to scrutiny.
Is our health care okay? Sure. Decent? Probably. Is it great? Hardly. Could we do better? Yes, much. Do we need to spend more? Maybe a tad, but not likely much, if any. To wit:
According to OECD data, on life expectancy Canada ranks 16th. On mortality rates from avoidable causes, we’re 23rd. On cancer survival rates we range from 13th down to 18th, depending on the cancer type. On the number of one-year-olds vaccinated for diphtheria, tetanus and pertussis, we rank an abysmal 37th (even the U.S. is higher here at 27th. Gulp.). One area where we do rank closer to the top is spending as a proportion of GDP, where we sit seventh.
World Health Organization (WHO) data wasn’t any more flattering, where Canada’s health care ranked 30th in overall performance despite being 10th in spending. The Commonwealth Fund ranks Canada 10th out of 11 in performance and 6th out of 11 in spending. In report after report Canadians aren’t getting the outcomes we need or want based on the money we’re spending on our current system.
Besides for reasons of nostalgia, why would anyone spend their energy defending these sorts of results? “We’re 16th! We’re 16th!” is hardly a chant you’d hear at a rally. It’s time to do better. And I get the feeling most people recognize this – certainly when you get onto Main Street.
Ipsos polling from December 2021 reported that 55 per cent of Canadians are “somewhat satisfied” with their health care, alongside 22 per cent that are “somewhat dissatisfied.” I.e. three quarters of Canadians find themselves in the middle of the road on the quality of our health care. This seems about right — mediocre support for mediocre health care. (The strongly satisfied and strongly dissatisfied were about even, at 12 per cent and 10 per cent respectively.)
But today Canadians are also, rightly, very worried. Leger polling in January 2023 showed that 86 per cent of Canadians are worried about the state of our health care.
(For the record, I count myself in the majority of both those polls: I am somewhat satisfied with our health care, while also being (very) worried about it.)
Next, we need to equally be clear about which systems are worthy of study and comparison based on their results.
Even a very cursory look at a couple key stats provides a starting point: using OECD data, Canada spends 10.8 per cent of our GDP on health care. If we start with countries that are +/- one per cent, that gives us a list of comparable spenders that includes Germany (11.7 per cent), Switzerland (11.3 per cent), France (11.1 per cent), Japan (11.0 per cent), Sweden (10.9 per cent), Belgium (10.7 per cent), Norway (10.5 per cent), Austria (10.4 per cent), Netherlands (10.2 per cent), the U.K. (10.2 per cent), and Denmark (10 per cent).
A quick cross-check of the spending list against which countries report better life expectancy than Canada does (i.e. countries that spend similarly on health care but whose citizens live longer than Canadians), narrows the list down to Switzerland, France, Japan, Sweden, Belgium, Norway and Netherlands. Germany, Austria, U.K., and Demark were removed, as Canada out-performs their life expectancies.
You can do a similar exercise with other OECD indicators — preventable deaths versus expenditure being one I would highlight. You can also do this with WHO data, or other datasets, widely available over the last number of years. They tell similar stories with similar players: there is a fairly consistent group of countries that Canadians should be looking to for inspiration. Places that have similar economic capacity devoted to health care as Canada but get better results for citizens.
Which brings us to the last element…
You know what country isn’t on any of these lists? The United States of America!
Ahem.
A careful reader will notice that the U.S. is absent from the lists of countries that spend similarly on heath care as Canada does, as well as the lists of countries that get better outcomes than Canada does. That’s because the U.S.’s health-care expenditures are other-worldly. We could never, never, spend — on a per capita basis — the amounts on health care as what our American friends do. And, and! They get even worse overall outcomes than we do — ranked lower basically across the board in both OECD and WHO data over any number of years.
That’s why there is nobody, anywhere, seriously suggesting that Canada should import American-style health care to our country. It simply isn’t an option on the table. The only people making this U.S.-importation strawman argument are people who are anti-progress.
It’s unfortunate how effective that argument has been over the years and the lack of progress as a result. It’s us Canadians who pay the price. We should be smarter and not fall for it.
With that, I remind readers of the three rules I proposed last year to frame the health-care debate. I stand by them:
We all agree that we’re compassionate, patriotic Canadians and together we understand that our health-care system must do better.
We all agree that nobody (literally: nobody) is seriously proposing that we recreate the U.S. health-care system in Canada.
We all agree to the (obvious) fact that there are numerous countries on our planet other than Canada and the United States.
There are numerous countries that we should be comparing our system against, learning from, and adopting for our uniquely Canadian realities of geography, climate, density, languages and population. A mature discussion about which elements from which systems we can learn from should not be beyond our capabilities.
Canada’s health care can and must be improved, but it starts with Canadians having a broader view of what’s possible.
Harrison Ruess is a campaign director and communications advisor in Ottawa. This essay is submitted as an individual.
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